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. 2012 Dec 6;28(2):326–338. doi: 10.1093/her/cys112

Table I.

Loss-framed messages communicating health risks using fear or guilt appeals—main themes raised in the focus groups

Message format—fear or guilt appeals Reactions to message content and format Example quote
  • Message 1: You know that tobacco may hurt you in the future. But do you know how it’s hurting you and your family now? She worries about her dad chewing tobacco. She saw what happened to her grandfather, and she is scared. He loves his dad, but he hates the way he smells. Yuck! A visitor came to the school today and explained that tobacco is bad for health. Does his dad know, he wonders? She wishes she had more money to fix some things around the house. She could do those things if he didn’t buy tobacco every day. Learn to quit tobacco with our program.

  • Picture showing a man in an armchair lighting up a cigar and a little girl next to the armchair holding her nose

  • Message 2: You know that tobacco is bad for your health. But we would like to tell you something else about tobacco. Using tobacco is an addiction, not a habit. This means that your body feels like it needs tobacco, not just wants it. It is the reason why people say they can’t stop, even when they know it’s bad for them. It’s why it can be hard for some people to quit. When you use tobacco, it hurts your body, even though you can’t see it. It increases your heart rate and your blood pressure. It gives you bad breath and puts you at risk for mouth sores. When you are addicted to tobacco long enough, the increased heart rate and blood pressure can lead to heart attack and stroke. The mouth sores can develop into oral cancer. Learn how to quit tobacco with our program.

  • Picture showing a person with a mouth ulcer.

  • Message 3: If it can happen to him, it can happen to you. Tobacco can hurt anyone. It doesn’t matter who you are, what you do or where you live. Tobacco doesn’t care if you have a family to support, or if you have lots of friends. It only wants to hurt you. You would never guess it, but Mahesh is already developing ulcers and sores in his mouth. He looks fine. He feels fine. He doesn’t even know they are there yet. But he is addicted to tobacco, and they will get worse. Learn to quit tobacco with our program.

  • Message 4: Sometimes things aren’t what they seem. If you use tobacco, everything may look fine from the outside. But everything is not fine on the inside. Even if you only use tobacco a few time a week, you are still taking a risk. You are putting dangerous chemicals into your body. And you make it more likely that you will become addicted in the future. Learn to quit tobacco with our program.

  • The general opinion voiced in the focus groups was that teachers were already educated about the harmful effects of tobacco and were aware of the risks of using it. Participants suggested including more specific evidence-based information in tobacco-related messages (e.g. information on short- and long-term effects of tobacco and chemicals contained in tobacco on both, tobacco users and passive smokers’ health).

  • The message format was deemed effective in making both teachers and students want to quit. Inclusion of more visual material to enhance the message requested.

  • Since teachers are intellectuals, they want to be informed about the logic of everything. If they understand the logic in these chemicals, they’ll collect more and more information regarding the health effects of these chemicals. They will discuss the impact of these chemicals, which will affect them to some extent.

  • All messages are written in the same size. It should be written in different font. The place where it is written that smoking increases the heart beat and blood pressure should be bold and underlined to make it effective.